investigation in primary care

Last edited 10/2020 and last reviewed 10/2020

• in all women with suspected PID, swabs for Chlamydia trachomatis and Neisseria gonorrhoea should be taken from the endocervix (and urethra) as a miniumum (1)
  • a negative swab result does not exclude PID (2).
• endocervical or vaginal pus cells on a wet-mount vaginal smear
  • although the presence of cells is non specific the absence of cells indicates that PID is unlikely (95%) (3)
• other tests such as a pregnancy test (to exclude ectopic pregnancy) (3), urinanalysis and urine culture may help exclude other causes of lower abdominal pain
  

Tests generally undertaken in secondary care environment may also include:

• FBC (leucocytosis), ESR (raised), CRP (raised); useful in assessing disease severity (3) but can be normal in mild or moderate disease (1)
• other tests which may be useful include - LFTs (raised in perihepatitis) and blood cultures (if pyrexial)

Advice may be required from microbiology and genito-urinary medicine (GUM) departments concerning current diagnostic methods for causes of PID.

Notes (4):

• PID has a prevalence of between 2% and 12%, and it cannot be diagnosed reliably from clinical symptoms and signs, which have a positive predictive value for salpingitis of only 65% to 90% compared with laparoscopy

Reference:

1. The International Union against Sexually Transmitted Infections 2008. European Guideline for the Management of Pelvic Inflammatory Disease
2. British association for sexual health and HIV. Guidelines for the Management of Pelvic Infection and Perihepatitis  
3. Royal college of obstetricians and gynaecologists 2008. Managemnet of acute pelvic inflammatory disease
4. Savaris RF et al. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD010285. DOI:0.1002/14651858.CD010285.pub3.